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Ricardo Moreno-cabral - One of the best experts on this subject based on the ideXlab platform.
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Delayed Management of Partial Aortic Valve Avulsion After Transcatheter Aortic Valve Replacement.
The Annals of thoracic surgery, 2017Co-Authors: Dimitri Sherev, Khalid Azizi, Nassir A. Azimi, Susan Van Nordheim, Ricardo Moreno-cabralAbstract:We report a case of delayed treatment of a partial aortic valve leaflet avulsion during transcatheter aortic valve replacement (TAVR) and its successful management by a percutaneous snare retrieval technique. Post-TAVR transesophogeal echocardiography showed an avulsed native valve leaflet. We deferred retrieval of the mass with Anticoagulant Agents. One month later, a 30-mm EN-Snare was used to snare the mass. This case report demonstrates that the management of an avulsed aortic valve leaflet can be safely deferred with the use of an Anticoagulant Agent. Snare retrieval of the avulsed valve can be achieved under local anesthesia with close neurological monitoring.
Jurrien Ten M Berg - One of the best experts on this subject based on the ideXlab platform.
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bivalirudin versus heparin anticoagulation in transcatheter aortic valve replacement the randomized bravo 3 trial
Journal of the American College of Cardiology, 2015Co-Authors: George Dangas, Thierry Lefevre, Christian Kupatt, Didier Tchetche, Ulrich Schafer, Nicolas Dumonteil, John G Webb, Antonio Colombo, Stephan Windecker, Jurrien Ten M BergAbstract:BACKGROUND Anticoagulation is required during transcatheter aortic valve replacement (TAVR) procedures. Although an optimal regimen has not been determined, heparin is mainly used. Direct thrombin inhibition with bivalirudin may be an effective alternative to heparin as the procedural Anticoagulant Agent in this setting. OBJECTIVES The goal of this study was to determine whether bivalirudin offers an alternative to heparin as the procedural Anticoagulant Agent in patients undergoing TAVR. METHODS A total of 802 patients with aortic stenosis were randomized to undergo transfemoral TAVR with bivalirudin versus unfractionated heparin during the procedure. The 2 primary endpoints were major bleeding within 48 h or before hospital discharge (whichever occurred first) and 30-day net adverse clinical events, defined as the combination of major adverse cardiovascular events (all-cause mortality, myocardial infarction, or stroke) and major bleeding. RESULTS Anticoagulation with bivalirudin versus heparin did not meet superiority because it did not result in significantly lower rates of major bleeding at 48 h (6.9% vs. 9.0%; relative risk: 0.77; 95% confidence interval [CI]: 0.48 to 1.23; p = 0.27) or net adverse cardiovascular events at 30 days (14.4% vs. 16.1%; relative risk: 0.89; 95% CI: 0.64 to 1.24; risk difference: -1.72; 95% CI: -6.70 to 3.25; p = 0.50); regarding the latter, the prespecified noninferiority hypothesis was met (pnoninferiority < 0.01). Rates of major adverse cardiovascular events at 48 h were not significantly different (3.5% vs. 4.8%; relative risk: 0.73; 95% CI: 0.37 to 1.43; p = 0.35). At 48 h, the bivalirudin group had significantly fewer myocardial infarctions but more acute kidney injury events than the heparin group; at 30 days, these differences were no longer significant. CONCLUSIONS In this randomized trial of TAVR procedural pharmacotherapy, bivalirudin did not reduce rates of major bleeding at 48 h or net adverse cardiovascular events within 30 days compared with heparin. Although superiority was not shown, the noninferiority hypothesis was met with respect to the latter factor. Given the lower cost, heparin should remain the standard of care, and bivalirudin can be an alternative Anticoagulant option in patients unable to receive heparin in TAVR. (International, Multi-center, Open-label, Randomized Controlled Trial in Patients Undergoing TAVR to Determine the Treatment Effect [Both Safety and Efficacy] of Using Bivalirudin Instead of UFH [BRAVO-2/3]; NCT01651780).
Dimitri Sherev - One of the best experts on this subject based on the ideXlab platform.
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Delayed Management of Partial Aortic Valve Avulsion After Transcatheter Aortic Valve Replacement.
The Annals of thoracic surgery, 2017Co-Authors: Dimitri Sherev, Khalid Azizi, Nassir A. Azimi, Susan Van Nordheim, Ricardo Moreno-cabralAbstract:We report a case of delayed treatment of a partial aortic valve leaflet avulsion during transcatheter aortic valve replacement (TAVR) and its successful management by a percutaneous snare retrieval technique. Post-TAVR transesophogeal echocardiography showed an avulsed native valve leaflet. We deferred retrieval of the mass with Anticoagulant Agents. One month later, a 30-mm EN-Snare was used to snare the mass. This case report demonstrates that the management of an avulsed aortic valve leaflet can be safely deferred with the use of an Anticoagulant Agent. Snare retrieval of the avulsed valve can be achieved under local anesthesia with close neurological monitoring.
Harish Ramakrishna - One of the best experts on this subject based on the ideXlab platform.
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bivalirudin versus heparin in patients undergoing percutaneous transcatheter aortic valve interventions a systematic review and meta analysis
Journal of Interventional Cardiology, 2017Co-Authors: Pedro A. Villablanca, Michael Weinreich, Tanush Gupta, Divyanshu Mohananey, Rasha Albawardy, Carola Maraboto, David F Briceno, Harish RamakrishnaAbstract:Background Bivalirudin may be an effective anticoagulation alternative to heparin as Anticoagulant Agent in percutaneous transcatheter aortic valve interventions (PAVI). We aimed to compare safety and efficacy of bivalirudin versus heparin as the procedural Anticoagulant Agent in patients undergoing PAVI. Methods We conducted an electronic database search of all published data. The primary efficacy endpoints were all-cause mortality, cardiovascular mortality, myocardial infarction, and stroke. Safety endpoints include major and life-threatening bleed according to VARC and BARC bleeding, blood transfusion, vascular complications, and acute kidney injury. Odds ratios (OR) and 95% confidence intervals (CI) computed using the Mantel-Haenszel method. Results Three studies (n = 1690 patients) were included, one randomized trial and two observational studies. There was a significant difference favoring bivalirudin over heparin for myocardial infarction (OR 0.41, 95%CI 0.20-0.87). There was no significant difference in all-cause mortality at 30 days (OR 0.97, 95%CI 0.62-1.52), cardiovascular mortality (OR 1.03, 95%CI 0.52-2.05), stroke (OR 1.23, 95%CI 0.62-2.46), vascular complications (OR 0.96, 95%CI 0.70-1.32), acute kidney injury (OR 1.03, 95%CI 0.53-2.00), blood transfusion (OR 0.67, 95% CI 0.45-1.01), major and life-threatening bleed (OR 0.74, 95%CI 0.37-1.49), and BARC bleeding (OR 0.52, 95%CI 0.23-1.18). Conclusions In patient undergoing aortic valve interventions, no difference was seen between the use of bivalirudin and heparin as the procedural Anticoagulant Agent, except for a significant lower myocardial infarction events when bivalirudin was used. Further large randomized trials are needed to confirm current results.
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TCT-683 Bivalirudin versus Heparin in Patients Undergoing Percutaneous Peripheral Interventions: A Systematic Review and Meta-analysis
Journal of the American College of Cardiology, 2017Co-Authors: Wilman Olmedo, Pedro A. Villablanca, Michael Weinreich, Tanush Gupta, Divyanshu Mohananey, Thomas Brevik, Cristina Sanina, Jeannine Brevik, Muhammad Farooq, Harish RamakrishnaAbstract:Bivalirudin may be an effective anticoagulation alternative to heparin as Anticoagulant Agent in percutaneous peripheral interventions (PPI). We aimed to compare safety and efficacy of bivalirudin versus heparin as the procedural Anticoagulant Agent in patients undergoing PPI. We conducted an
Souhir Abid - One of the best experts on this subject based on the ideXlab platform.
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(E)-N'-(1-(3-oxo-3H-benzo[f]chromen-2-yl)ethylidene)benzohydrazide protecting rat heart tissues from isoproterenol toxicity: Evidence from in vitro and in vivo tests
European Journal of Pharmacology, 2020Co-Authors: Khdhiri Emna, Kais Mnafgui, Lakhdar Ghazouani, Anouar Feriani, Raouf Hajji, Walid Bouzanna, Noureddine Allouche, Jean-pierre Bazureau, Houcine Ammar, Souhir AbidAbstract:The current study was aimed to assess the protective effect of a new molecule (E)-N'-(1-(3-oxo-3H-benzo[f]chromen-2-yl)ethylidene)benzohydrazide, denoted 1c, against cardiac remodeling process in isoproterenol (Isop) induced myocardial infarction (MI) in rats. Male Wistar rats were randomly divided into four groups, control, Isop (85 mg/kg body weight was injected subcutaneously into rats at an interval of 24 h for 2 days (6 and 7 day) to induce MI and pretreated animals with acenocoumarol (Ace) (150 μg/kg bw) and 1c (150 μg/kg bw) by oral administration during 7 days and injected with isoproterenol (Isop + Ace) and (Isop + 1c) groups. Results in vitro showed that 1c is endowed with potent inhibition of angiotensin-converting enzyme (ACE) with an IC 39.12 μg/ml. The in vivo exploration evidenced alteration in the ECG pattern, notable cardiac hypertrophy and increase in plasma level of fibrinogen, troponin-T, CK-MB and LDH, AST and ALT by 171%, 300%, 50%, 64% and 75% respectively with histological myocardium necrosis and cells inflammatory infiltration. However, pre-treatment with 1c improved the ECG pattern reduced significantly the cardiac dysfunction markers and ameliorated the thrombolytic process by decreasing fibrinogen level as compared to untreated infracted rats. Overall, (E)-N'-(1-(3-oxo-3H-benzo[f]chromen-2-yl)ethylidene)benzohydrazide 1c could be used as Anticoagulant Agent to prevent thrombosis in acute myocardial infarction.